I think your fish oil question is definitely a fair one. He / she may still be a very good doc, just not up-to-date on the prevention research. I'd be most interested in how he/she will be following your pregnancy, how and how often you and baby will be monitored, what kinds of things he'd find reassuring or more worrisome as your pregnancy progresses, and how aggressive / willing to wait and see when it comes to delivery indications.

I think your fish oil question is definitely a fair one. He / she may still be a very good doc, just not up-to-date on the prevention research. I'd be most interested in how he/she will be following your pregnancy, how and how often you and baby will be monitored, what kinds of things he'd find reassuring or more worrisome as your pregnancy progresses, and how aggressive / willing to wait and see when it comes to delivery indications.

This study demonstrates that aPL perturb the secretion of trophoblast angiogenic factors. LMWH does not reverse this effect but exacerbates sFlt-1 secretion, a potent anti-angiogenic factor. These findings may help to explain why women with antiphospholipid syndrome, who are treated with heparin to prevent early pregnancy loss, remain at increased risk of developing late obstetrical complications, such as pre-eclampsia...

That last is an example of why I always say to run supplements past your MFMs!

Anyway, I doubt thinning the blood per se will do anything. If blood thinners like heparin/Lovenox/LDA are doing anything at all (and a lot of MFMs would say at least LDA is not, given the data from randomized controlled trials) it's likely because of something else that they do too, and not just because they thin the blood.

Oh! And on that note here's *another* new study reporting the same thing: http://www.ncbi.nlm.nih.gov/pubmed/21545366

[i]This study demonstrates that aPL perturb the secretion of trophoblast angiogenic factors. LMWH does not reverse this effect but exacerbates sFlt-1 secretion, a potent anti-angiogenic factor. These findings may help to explain why women with antiphospholipid syndrome, who are treated with heparin to prevent early pregnancy loss, remain at increased risk of developing late obstetrical complications, such as pre-eclampsia...[/i]

Also, fish oil got ruled out a while ago: http://www.ncbi.nlm.nih.gov/pubmed/18669736

[i] Supplementation with fish oil, calcium, or vitamin C and E and the use of antihypertensives have been shown to be ineffective in the prevention of recurrent preeclampsia and are not recommended. [/i]

and has the potential to worsen matters (in this study it made you almost *5 times* more likely to get it): http://www.ncbi.nlm.nih.gov/pubmed/16487202?dopt=AbstractPlus

That last is an example of why I always say to run supplements past your MFMs!

Anyway, I doubt thinning the blood per se will do anything. If blood thinners like heparin/Lovenox/LDA are doing anything at all (and a lot of MFMs would say at least LDA is not, given the data from randomized controlled trials) it's likely because of something else that they do too, and not just because they thin the blood.

You know it isn't that aspirin/heparin are blood thinners that's the theoretical mechanism in play, though? They used to think it was because it might thin the blood; now researchers think if there's any effect it's because of the antiinflammatory effect these have because of other biochemical cascades that they trigger.

Also, at the CME this weekend we learned that there's a new paper coming out in _Circulation_ this month which shows that heparin (maybe also Lovenox?) *upregulates* soluble flt, which is pretty counterintuitive as a means of preeclampsia prevention!

You know it isn't that aspirin/heparin are blood thinners that's the theoretical mechanism in play, though? They used to think it was because it might thin the blood; now researchers think if there's any effect it's because of the antiinflammatory effect these have because of other biochemical cascades that they trigger.

Also, at the CME this weekend we learned that there's a new paper coming out in _Circulation_ this month which shows that heparin (maybe also Lovenox?) *upregulates* soluble flt, which is pretty counterintuitive as a means of preeclampsia prevention!